Physical assaultiveness during personal care is, for family and professional caregivers, the most disturbing disruptive behavior occurring in older persons with Alzheimer's disease and related disorders. The personal care activity most associated with physically assaultive behavior is bathing. The overall purpose of the proposed study is to increase the understanding of how, why, and under what circumstances physical assaults occur among demented residents known to be at high risk for violence, and to identify factors and cues present during the act of bathing that are antecedents of assaultive behavior. Specific aims are to: (l) determine the extent to which assaultive behavior can be predicted by patterns of agitation during the bath; (2) evaluate the relationship between caregiver actions and the onset of assaultive behavior, and (3) develop an explanatory model of assaultiveness that takes into account joint efforts of multiple factors. Two hundred and seventy videotapes of routine bathing activities on 90 nursing home residents with Alzheimer's disease or a related dementia and a history of disruptive behavior during bathing will be analyzed in the proposed research. Approximately half of these videotapes will contain assaultive episodes. The study will analyze these videotapes using a computerized behavior observation package, which will allow the onset of assaultive behavior to be related to the following categories of explanatory variables: caregiver behaviors, bathing tasks, subject emotional state (including agitation and discomfort), and physical environment. In addition, a variety of background data on the subjects and caregivers will be considered. Statistical analyses will test the study hypotheses and components of a theoretical model of assaultive behavior, beginning with descriptive and correlational techniques, and progressing to test hypotheses using multivariate methods, including generalized estimating equations (to study the relationship between risk factors and assaultiveness) and time- dependent analyses such as lag-sequential analysis (to study the timing of these relationships.) Results of the study will help develop and refine interventions to prevent or minimize assaultive behavior during bathing. Findings are expected to generalize to other personal care activities as well.